Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. 2003;85-A:1051–7. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. It had Great information My son will have to stay in his room for much of the first part of recovery, due to the only bathrooms we have are upstairs. incidence. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). However, when the characteristics of a lesion require the use osteochondral transplantation, an open approach with a malleolar osteotomy is a feasible option. When osteochondritis dissecans affects the ankle it typically occurs on the inner or medial portion of the ankle (talus). Foot Ankle Int. The aim of the present study was to examine the clinical outcomes after HemiCAP ® implantation for OCDs of the medial talar dome after failed previous surgery. Therefore, an osteotomy must be placed through the tibial to access the ankle. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point . The articular surface of these facets is contiguous with the superior articular surface of the talar dome. Contraindicated for large OCLs, limited range of motion, and narrow joints, Horizontal cut results in no perpendicular access, Difficult to fix the fragment perpendicular to the cut, Excellent congruity when the cut is made 30° relative to long axis of the tibia, Outcomes vary; fragment migration seen when fixation is not perpendicular to cut; requires precise cut 30° to tibia, Amount of exposure, advantages, and disadvantages of medial malleolar osteotomy techniques are outlined for comparison [, The Chevron-type medial malleolar osteotomy has been described several times previously [, A Chevron cut is made in the medial malleolus after predrilling the fixation holes and placing a guidewire for osteotomy direction (Illustrations copyright of and reproduced with permission from JG Kennedy MD. �����YL�L���>x�К`~C��W��̋]?`/```}�+��n��Y��&2����cWU�Y�]޿.%��z��)�0TL�9��0S���D �q�ό�+�8@r���5��@���[G�g_ �A.de�vJ�*�0 $+W This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). 105 0 obj <> endobj Both magnetic resonance (MR) imaging and ankle arthroscopy are excellent tools commonly used to evaluate ankle cartilage (3–5). Talar dome lesions are usually caused by … Reproduction without express written consent is prohibited), An oblique osteotomy provides adequate visualization of the talus and good congruity when executed properly [, Arthroscopic approaches are well established, minimally invasive, and can provide access to most OCLs. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. 6, and 9 cases, respec- tively. See the main osteochondritis dissecans article for a general discussion on … 3. This approach allows access to 80% of the talar dome while it avoids the medial malleolar osteotomy in most cases. %%EOF Medial osteochondral lesions are more common than lateral osteochondral lesions. Outcome of resection of a symptomatic os trigonum. H��W�n�H}�W�QZD4��}�b0�#gf$��X�}H�A�I�Di,�F�~���/����I�ou9u���o���-~������m��_}};-���jxUJ^p.��)�Ь)&�M�L��^���`���wU�:^�) 7����fVUU��n���B����ȦX쮮���v��՛p���E�[������cQ�F��8. The bone lesions on the lateral or outside portion of the talus are most often related to trauma. The most common sites are the posteromedial (53%) (Fig. 1) and anterolateral (46%) talar dome (1). 2 children had had pain only and no history of a trauma. A history of acute trauma was recorded in 1 I of the 18 patients: 4 distortions, 4 falls, 2 direct traumas and 1 traffic accident. 69% of ankle fractures. This approach is recommended when preoperative imaging indicates an OCL is in an accessible location and does not require full visualization or open treatment [, A medial malleolar osteotomy should be avoided when an arthroscopic approach can provide access and allow satisfactory treatment of an OCL. mechanism of injury that causes talar dome fractures. Lateral lesions, which are more commonly associated with a traumatic injury, are described as shallow and have the tendency to become displaced. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, … 0 Osteochondritis dissecans (OCD) of the talus is rare in children. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. endstream endobj 106 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/SinglePage/Pages 103 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 107 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 108 0 obj <>stream :\6U�p4�+��n �sY�_MX_��v�߂�b���v��|��#q�i�x=���#xQ{/02p���|��_�f�B1�z�U��\x�� .p�5ij�Z�V�d�6�]}}��'�bt�OU���(y1z?�@�������ܣ�ϯ��&c��?�K���oǴ���A���O� o��xע�m���bJv�D�h�NkW�5�}G��6��Fn�. The medial and lateral articular facets of the talus articulate with the medial and lateral malleoli. Most cases of osteochondritis dissecans of the talus occur around the time of skeletal maturity (10-14 years of age for girls and 12-16 years of age for boys). “Osteo” means bone and “chondral” refers to cartilage. Osteochondral defect; 13 public playlist includes this case. medial on the talar dome in 3. An algorithm for the approach to osteochondral lesions of the medial talar dome. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Flattening of the medial talar dome. for OCD of the talus at a major Canadian pediatric referral center. Alexander IJ, Watson JT. The defects cause deep ankle pain associated with weightbearing. Ultimately, lesion size and characteristics will impact the treatment of choice and therefore the approach used. 150 0 obj <>/Filter/FlateDecode/ID[<930980570CEFAF47B7D27834AAA75355>]/Index[105 67]/Info 104 0 R/Length 194/Prev 738197/Root 106 0 R/Size 172/Type/XRef/W[1 3 1]>>stream Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. the talar dome) in the ankle. *���u7u��pD{{D=^��׊#�Om���O+����h|��m�҇��1�j?�OI{�W��`��V�&ܦ�Hg��ʹ�����X��ٔ�C�b�����Յ�;�( �-��f�\z���O�m0_4R�.�E7'ےz��4Ax�!X�n����uƾ� ܩnm������ܘ���n�n�5��x���5T-�J�ADP� �t���,_�_;�;†��6��X���X��I��X�|� In addition, there is a risk of fragment migration when fixation screws are not applied properly [. ?-[$�ih\�^�z�� N�F>(2ku$CR�d�~w��oI��ŕҽ�H�+b�J��$��}��Q����GE8C/M���p��З������)N��C���#�p& ����)j�%CM��x�,*$�j���3E�X%���y}k�o0�� ��|Xo��3�{W��z�fJ��^{���wa�rʕ�w��3|?�]��E��I����y���$̛�ݔ��4I�WS��4+{��7Qaf�1m�U:3���-��0��ǀpO ���=6.�ʚ-MȷhY����Y��FKo�ҥ��sg�|>�5� ,�x�qT|��T+�p_~��Qi�8�q٪�����]�B��A�4�/�i�J���,;k/b{|T*o�>�d�(�f���T����w����w���`��O; Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. The first revealed an OCD Lesion of the medial Talar dome, an injury that affected the cartilage between his Talus and Tibia and caused him pain and a ‘catching’ at the joint. A partial fluid cleft at its posterior margin and a mild subchondral oedema suggests an unstable lesion. Oblique osteotomy requires precision, and adverse outcomes have been reported. Reproduction without express written consent is prohibited), The osteotomy cut is terminated just prior to reaching the subchondral bone and completed with an osteotome (Illustrations copyright of and reproduced with permission from JG Kennedy MD. OCL location and characteristics must therefore be considered when planning the surgical approach (Fig. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. Type-G lesions could also stem from excessive stresses on the medial side of the talar dome, associated with vascular or metabolic modifications, leading to deep necrosis farther from the subchondral bone than in type-O lesions. Other joints – Approximately 15 percent. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. �m�SJm�kk=�n��Û~�D˷Vs�B3�}g�-g�K���1e�����+7;�ި��I�O�KC(�����0_U;��X^���,����%횰u�e}�i�͒t�]%i?-���$ɋr��r�h=�}@��9����i�K8D[NS����b����M�V#�/�J�Dsny�6+���h�qD�c��:�E1FB-�\mQ�-�i�o�p�X��c}A���_�C! 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